Question:
Can an individual file for coverage if a physician will not?

Since my surgeon will not file medicare, and is requiring me to pay his fee up front, can I, as an individual file to recover my fees? And if so, what codes would be appropriate? Thanks so much, and good luck to you all!    — Sunnisunshine (posted on October 24, 2003)

October 24, 2003
Even if your dr won't file the papers himself, he has to give you something you can file with an insurance company. Ask him for a standard HCFA form. That should have all the information required. You might check with Medicare on their paying, tho. My husband just got his Medicare booklet for the year and there was something in there about if the dr wouldn't participate, they might not pay. Good luck.
   — lharbison

October 24, 2003
This is directly from the 'medicare site. My Physician or Supplier Does Not Accept Medicare Assignment Note: Only physicians and suppliers can decide not to accept assignment. If your physician or supplier does not accept assignment for covered services, your physician or supplier may require that you pay most or all of the bill at the time you receive services or supplies. However, the physician or supplier is still required to file a Medicare claim on your behalf. Medicare then pays its share of the bill directly to you. Medicare cannot pay you its share of the bill until a Medicare claim is filed. You should take the following steps if your doctor or supplier does not file the Medicare claim in a timely manner. Bottom line is DR still has to file your medicare claim for you; and the payment will go to you.!!!!
   — star .

October 26, 2003
If your surgeon will not file this for you, he must provide you with an itemized statement showing you have paid the bill and he doesn't accept assignment. You will also need your letter from the doctor showing medical necessity for this procedure, including your BMI, height,weight and co-morbidities. Good Luck.
   — Carolyn B.

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